Latex allergy OSCE — perioperative safety and family counselling

Station objectives

1. Perform preoperative latex-risk assessment of a child with spina bifida and plan latex-safe surgery. [5]
2. Apply component-resolved diagnostics appropriately and interpret Hev b components. [8]
3. Counsel a family on latex avoidance, latex-fruit syndrome, and adrenaline use. [6] [12]

Candidate brief

You are the paediatric doctor in an allergy clinic. Station A is 8 minutes (preoperative latex-risk assessment and latex-safe surgery planning for a child with spina bifida). Station B is 8 minutes (counselling a family about latex avoidance, latex-fruit syndrome, and adrenaline). Examiners score safety prioritisation, evidence use, and partnership with families. [1] [5]

Station A — Preoperative latex-risk assessment

Setup: A four-year-old with myelomeningocele and a VP shunt is scheduled for elective urological surgery. She has never had a latex reaction, and latex-specific IgE has not been tested. The surgeon asks whether latex precautions are needed. [5]

Expected actions:

• Recognise spina bifida as the highest-risk group for latex sensitisation (historically 30 to 70 per cent). Institute latex-safe precautions until testing clarifies, regardless of prior reaction history. [5]
• Take a focused latex exposure history: gloves, balloons, catheters, dental procedures, and any reactions to banana, kiwi, avocado or chestnut (latex-fruit syndrome clue). [6]
• Plan testing: skin-prick testing with latex extract, serum latex-specific IgE, and component-resolved diagnostics (Hev b components) to determine the phenotype and risk. [8]
• Plan latex-safe surgery: first case of the day, latex-free operating room, removal of all powdered latex gloves from the entire suite, latex-free equipment and instruments, and staff awareness. [5]
• Explain to the surgeon that the first systemic presentation may be intraoperative anaphylaxis, which is why pre-emptive latex-safe precautions are mandatory. [12]

Station B — Counselling latex avoidance and latex-fruit syndrome

Setup: A seven-year-old with confirmed Type I latex allergy (Hev b 1 and Hev b 5 positive on component testing) is in clinic with her parents. They ask what she needs to avoid, whether she can eat banana, and whether she needs an adrenaline device. [1]

Expected actions:

• Explain strict latex avoidance: latex-free gloves, catheters and medical devices; avoid balloons, rubber bands, latex erasers, and latex-containing household items. The goal is complete elimination of latex contact. [1]
• Counsel on latex-fruit syndrome: Hev b 6 hevein cross-reacts with class I chitinases in banana, kiwi, avocado, chestnut and passion fruit. Up to half of latex-allergic children react to at least one fruit. Advise caution and avoid only those foods that cause reactions. [6]
• Prescribe a weight-banded adrenaline autoinjector and a written anaphylaxis action plan (ASCIA/BSACI/FARE), because her Hev b 1 and Hev b 5 sensitisation indicates genuine latex allergy with systemic risk. [12]
• Provide medical alert identification and proactively notify the school, dentist, and all treating clinicians. [1]
• Explain the latex-safe surgery protocol for future procedures and arrange periodic specialist review. [5]

Marking anchors

Clear pass: recognises spina bifida as highest-risk and institutes latex-safe precautions pre-emptively in Station A; explains latex-fruit syndrome mechanism and prescribes adrenaline for the genuine-allergy child in Station B; demonstrates partnership with the family and the surgical team. [5] [12] Borderline: identifies spina bifida risk but does not explain the latex-safe protocol fully; or counsels latex avoidance but omits latex-fruit syndrome counselling or the adrenaline device. [1] [6] Fail: proceeds without latex-safe precautions in the spina bifida child; or fails to prescribe adrenaline for a genuine-allergy (Hev b 1/5 positive) child; or cannot explain the mechanism of latex-fruit syndrome. [12] [6]

Debrief pearls

• Any child with spina bifida gets latex-safe surgery until tests prove otherwise — the first systemic presentation may be intraoperative anaphylaxis. [5]
• Hev b 1 and Hev b 5 indicate genuine latex allergy with anaphylaxis risk — prescribe adrenaline. Hev b 8 profilin alone is often low-risk. [8]
• Latex-fruit syndrome: ask about banana, kiwi, avocado, chestnut in every latex-allergic child. [6]
• Powdered latex gloves elsewhere in the operating suite can trigger a reaction — eliminate them from the suite, not just the bedside. [11]